Creighton Model FertilityCare System

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Creighton Model / FertilityCare
Birth control type Behavioral
First use 1980
Failure rates (first year)
Perfect use 0.5%
Typical use 3.2%(J Reprod Med 1998;43:495-502)
Reversibility Immediate
User reminders Accurate instruction & daily charting are key.
Clinic review None
Advantages and disadvantages
STD protection No
Period advantages Prediction
Weight gain No
Benefits Low direct cost;
no side effects;
in accord with Catholic teachings;
may be used to aid pregnancy achievement

The Creighton Model FertilityCare System (Creighton Model, FertilityCare, CrMS) is a form of natural family planning which involves identifying the fertile period during a woman's menstrual cycle. The Creighton Model was developed by Dr Thomas Hilgers, the founder and director of the Pope Paul VI Institute. This model, like the Billings ovulation method, is based on observations of cervical mucus to track fertility.


Dr Thomas Hilgers began research in 1976 which led to the development of the Creighton Model FertilityCare System, which was first fully described (as the Creighton Model) in 1980.[1] In 1981, the American Academy of Natural Family Planning was founded to promote use of the Creighton Model as a form of natural family planning (the term for methods of family planning approved by the Roman Catholic church).[2] In 1985, Hilgers created the Pope Paul VI Institute to medically support the directives given by Pope Paul VI in Humanae Vitae: On the Regulation of Birth.

In 1991, Hilgers self-published a manual titled The Medical Applications Of Natural Family Planning: A Physician’s Guide to NaProTECHNOLOGY through his Pope Paul VI Institute Press. NaProTechnology is described as Natural Procreative Technology. In 2001, the AANFP was renamed the American Academy of FertilityCare Professionals, to reflect the relabeling of the Creighton Model as FertilityCare. In 2004, Hilgers self-published a reference manual titled The Medical and Surgical Practice of NaProTECHNOLOGY. Hilgers refers to the Creighton Model FertilityCare System as "the foundational family planning system to NaProTechnology".

Hilgers describes the Creighton Model as being based on "a standardized modification of the Billings ovulation method", which was developed by John and Evelyn Billings in the 1960s.[1] The Billingses issued a paper refuting the claim that the CrMS represents a standardization of the BOM.[3] They are two different methods and should not be seen as interchangeable.


A foundational principle of Dr. Hilgers’ teaching is the concept of fertility appreciation: “The ability to mutually value, respect, and understand one’s fertility.” (Hilgers, 2004). With the CrMS, it is important to understand that a couple’s fertility is not to be seen as something that must be cured or suppressed, but as an essential component of health and wellness. For these principles, NaProTechnology and CrMS work by gaining understanding of a woman’s menstrual and fertility cycles, and using this understanding of certain biological indications in order to avoid or achieve a pregnancy. By using the information learned through the CrMS, procreative and gynecologic health may be encouraged and monitored by women throughout their lives.


The basis of CrMS is observation of biological signs that indicate fertile or infertile times in a woman’s fertility cycle. These biological signs include observation of different types of cervical mucus and various bleeding patterns. As ovulation approaches, mucus production, quantity, stretch ability, and clarity increase as a result of rising estrogen levels. Once ovulation has occurred, the mucus will change, becoming more cloudy and thick, due to the rise in progesterone. Through observation and careful charting of these biological signs, a couple may effectively utilize this information in monitoring fertility.

Each new cycle starts with the menses. Due to the possibility of a short pre-ovulation phase, any vaginal bleeding is considered fertile when trying to avoid pregnancy. Any brown bleeding at the end of a period may be a sign of a progesterone deficiency. On light, very light, or days of brown bleeding, it is important to remember to check for mucus. As the estrogen levels rise, mucus is produced. Any mucus that is either clear, stretchy or lubricating is considered "peak-type" mucus, and days where it is noticed are considered fertile, as are the three days after. Any days where no mucus is observed or it is not peak-type (or in the count of three) are considered infertile and can be used for sex (if trying to avoid pregnancy). In the case of persistent cervical mucus, a different protocol is used.

To test for cervical mucus, the Creighton model uses only bathroom tissue. It must be folded, not crumpled. It is important to wipe front to back in order to feel for lubrication. This is to be done before and after every time using the restroom, including showers and shortly before bed.

Blood tests for estrogen levels prior to ovulation and for both Progesterone and estrogen levels after ovulation, ultrasound follicular tracking, and other diagnostic procedures, can be accurately timed according to the woman's cycle, using the data recorded on a couple's fertility chart. This allows doctors to make a more precise diagnosis of abnormalities, e.g. subtle hormonal deficiencies, various ovulation defects etc.

Doctors can use the fertility charts which couples are taught to keep as the basis for further investigations if needed.

Important to note is that women with fertility cycles not considered “normal” (such as women who are breast-feeding, have long or irregular cycles, are coming off contraceptive pills, have continuous discharge, anovulatory states or premenopause) can still successfully use the CrMS to regulate and monitor their abnormal fertility cycles and/or underlying medical conditions.


As a form of fertility awareness or natural family planning, the CrMS may be used[weasel words] to avoid pregnancy, or to increase chances of conception depending on the couple's intentions. The CrMS is used in conjunction with NaProTechnology (Natural Procreative Technology)[vague][clarification needed] to treat infertility. It is also used[citation needed] to treat other problems[peacock term] besides infertility such as:

Effectiveness in avoiding pregnancy[edit]

The effectiveness of the CrMS can be assessed two ways. Perfect use or method effectiveness rates only include people who follow all observational rules, correctly identify the fertile phase, and refrain from intercourse on days identified as fertile. Actual use, or typical use effectiveness rates are of all women intending to avoid pregnancy by using CrMS, including those who fail to meet the "perfect use" criteria.[7]

The Pope Paul VI Institute reports a perfect-use effectiveness rate of 99.5% in the first year.[8] In clinical studies of the CrMS conducted at the Pope Paul VI Institute, researchers excluded most pregnancies from the typical-use rate calculation, on the grounds that they believed the affected couples had used the method to deliberately attempt pregnancy.[9] The Institute reports a typical-use effectiveness of 96.8% in the first year, thus lower than other contraceptive methods.[8][10] Most studies of similar systems do not exclude such pregnancies from the typical-use failure rate.[11][12] However, the advantage of natural methods in the NaProTechnology is that it does not involve hormonal treatment and does not require an invasive procedure (as in case of vasectomy or tubal ligation).

Efectiveness in achieving pregnancy[edit]

No large clinical trials have been performed comparing ART and NaProTechnology. Only observational one-arm studies have been published so far.[13][14] In the larger of these two studies, 75% of couples trying to conceive received additional hormonal stimulation such as clomiphene.[13] Since NaProTechnology involves endocrinological diagnostics and cycle monitoring, both essential in the evidence-based infertility treatment preceding invasive ART procedures, a direct comparison of success rates between ART and NaProTechnology is currently not possible. Lower risk[weasel words] of multiples have been seen in comparison to ART[citation needed] and there has been no observed risk of OHSS.[citation needed] It also costs less than IVF (Hilger, 2006).[full citation needed]


  • Use of natural hormones and other medications to correct any hormonal disturbances or ovulation abnormality.
  • Use of medications if necessary to correct any other abnormalities e.g. cervical mucus deficiency, biochemical or haematological deficiencies, endocrine (glandular) deficiencies etc. to restore normal physiologic function, and thereby enhance fertility.
  • Referral to a gynaecologist if there are physical abnormailities needing surgery, for example


  1. ^ a b Creighton Model
  2. ^ American Academy of FertilityCare Professionals
  3. ^ Some Clarifications Concerning NaProTECHNOLOGY and the Billings Ovulation Method
  4. ^ "Premenstrual Syndrome". November 2012. 
  5. ^ "Surgical NaProTECHNOLOGY". November 2012. 
  6. ^ "Postpartum Depression". November 2012. 
  7. ^ Hatcher, RA; Trussel J; Stewart F; et al. (2000). Contraceptive Technology (18th ed.). New York: Ardent Media. ISBN 0-9664902-6-6. 
  8. ^ a b "CREIGHTON MODEL FertilityCare System: Effectiveness of the System". Retrieved 2008-07-16. 
  9. ^ Use effectiveness of the Creighton model ovulation...[J Obstet Gynecol Neonatal Nurs. 1994] - PubMed Result
  10. ^ "Comparison of birth control methods". 
  11. ^ Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). New York: HarperCollins. pp. 349–350. ISBN 0-06-093764-5. 
  12. ^ Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning (4th addition ed.). Cincinnati, OH: The Couple to Couple League. pp. 141–142. ISBN 0-926412-13-2. 
  13. ^ a b Stanford, Joseph B.; Parnell, Tracey A.; Boyle, Phil C. (2008-10-01). "Outcomes from treatment of infertility with natural procreative technology in an Irish general practice". Journal of the American Board of Family Medicine: JABFM 21 (5): 375–384. doi:10.3122/jabfm.2008.05.070239. ISSN 1557-2625. PMID 18772291. 
  14. ^ Tham, Elizabeth; Schliep, Karen; Stanford, Joseph (2012-05-01). "Natural procreative technology for infertility and recurrent miscarriage: outcomes in a Canadian family practice". Canadian Family Physician Médecin De Famille Canadien 58 (5): e267–274. ISSN 1715-5258. PMC 3352813. PMID 22734170. 

Hilgers, Thomas W.,M.D., The NaPro Technology Revolution: unleashing the Power in a Woman's Cycle. New York: Beaufort Books, 2010. Print.

Hilgers, Thomas W. The Medical & Surgical Practice of NaProTECHNOLOGY. Omaha: Pope Paul VI Institute, 2004. N. pag. Print.

Moore, Keith L., T,V.N Persaud, and Mark G. Torchia. Before we are Born Essentials of Embryology and Birth Defects. 8th ed. Philadelphia: Elsevier Inc., 2013. Print.

Unleashing the Power of a Woman's Cycle. Pope Paul VI Institute, 2006. Web. 14 Nov. 2012. <>.

Jemelka, B. E., & Parker, D. W., & Mirkes, R. (2013). State of the Art and Science NapProTECHNOLOGY and Conscientious OB/GYN Medicine. American Medical Association Journal of Ethics, 15. Retrieved from

Hilgers, T. W. (2011). The New Women’s Health Science of NaProTECHNOLOGY. Archives of Perinatal Medicine, 17(4). Retrieved from

Stanford, J. B., & Parnell, T. A., & Boyle, P. C. (2008). Outcomes from Treatment of Infertility with Natural Procreative Technology in an Irish General Practice, JABFM, 21 (5). Retrieved from

J Reprod Med 1998;43:495-502

External links[edit]